The treatment of acute myocardial infarction by combination of prehospital administered tenecteplase and acute PCI
Authors:
S. Janoušek 1; L. Groch 2; P. Urbánek 3; O. Hlinomaz 2
Authors‘ workplace:
Interní kardiologická klinika, FN Brno-Bohunice
1; I. interní kardioangiologická klinika FN u sv. Anny v Brně
2; ZZS Jihomoravského kraje
3
Published in:
Kardiol Rev Int Med 2008, 10(2): 58-60
Overview
Prehospital administration of IV bolus tenecteplase followed by acute PCI was used in 20 patients with STEMI (of which 16 men and 4 women with average age of 63 years [42 – 74 years) attended by emergency ambulance service in the region of South Moravia. Front wall STEMI, inferior wall STEMI and inferolateral MI accounted for 10 (50 %), 8 (40 %) and 2 (10 %) of cases, respectively. Coronarography performed at admission showed a fully patent (TIMI flow III) ‘infarct’ artery in 12 patients (60 %), a partially patent (TIMI flow I or II) artery in 4 patients (20 %), and a non-patent (TIMI flow 0) artery in 4 patients (20 %). The affected vessel was fully patent (TIMI fl ow 3 = 100 %) after PCI in all patients. 2 patients (10 %) developed only a minimum lesion (aborted infartion). None of the patients developed major complications and no rethromboses (reocclusions), reinfarctions or serious hemorrhage were observed in any of the patients after the administration of TNK and acute coronarography which followed, including angioplasty, or during subsequent hospitalisation. The zero hospitalisation, 30-day and one-year mortality rates are very encouraging.
Key words
acute myocardial infarction – prehospital thrombolysis – coronary angioplasty – mortality – complications
Sources
1. Morrison LJ, Verbeek PR, McDonald AC et al. Mortality and Prehospital Thrombolysis for Acute Myocardial Infarction. JAMA 2000; 283(20): 2686-2692.
2. Rawles JM. Quantification of the benefit of earlier thrombolytic therapy: five-year results of the Grampian Region Early Anistreplase Trial (GREAT). J Am Coll Cardiol 1997; 30(5): 1181-1186.
3. Boersma E, Akkerhuis M, Simoons ML. Primary angioplasty versus thrombolysis for acute myocardial infarction. N Engl J Med 2000; 342(12): 890-892.
4. Zijlstra F, Hoortnje JCA, de Boer MJ et al. Long-term benefit of primary angioplasty as compared with thrombolytic therapy for acute myocardial infarction. N Engl J Med 1999; 341(19): 1413-1419.
5. Janoušek S. Přednemocniční trombolýza. Interv Akut Kardiol 2003; 2(2): 184-189.
6. Bonnefoy E, Lapostolle F, Leizorovicz A et al. Comparison of angioplasty and prehospital thromboysis in acute myocardial infarction (CAPTIM) study group. Lancet 2002; 360(9336): 825-829.
7. Steg PG, Bonnefoy E, Chabaud S et al. Impact of Time to Treatment on Mortality After Prehospital Fibrinolysis or Primary Angioplasty: Data From the CAPTIM Randomized Clinical Trial. Circulation 2003; 108(23): 2851-2856.
8. The Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT)-3 Investigators. Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: the ASSENT-3 randomised trial in acute myocardial infarction. Lancet 2001; 358(9282): 605-613.
9. Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) investigators. Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomised trial. Lancet 2006; 367(9510): 569-578.
10. Teher T, Fu Y, Wagner GS et al. Aborted myocardial infarction in patients with ST-segment elevation: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen-3 Trial Electrocardiographic Substudy. J Am Coll Cardiol 2004; 44(1): 38-43.
11. Levine MN, Goldhaber SZ, Gore JM et al. Hemorrhagic complications of thrombolytic therapy in the treatment of myocardial infarction and venous thromboembolism. Chest 1995; 108(Suppl 4): 291S-301S.
12. Patel SC, Mody A. Cerebral hemorrhagic complications of thrombolytic therapy. Prog Cardiovasc Dis 1999; 42(3): 217-233.
13. Janoušek S. Má ještě streptokináza místo v léčbě akutního infarktu myokardu? Vnitř Lék 2003; 49(11): 880-884.
14. Janoušek S. Trombolytická (fibrinolytická) léčba akutního infarktu myokardu. KF 2006; 4(1): 66-80.
15. Mcdonald MA, Fu Y, Zeymer U, WagnerG et al Adverse outcomes in fibrinolytic-based facilitated percutaneous coronary intervention: insights from the ASSENT-4 PCI electrocardiographic substudy. Eur Heart J 2008; 29(7): 871-879.
16. Ellis SG. ESC Annual Congress, Vienna, 2. 9. 2007. Late-breaking Trial Congress Report Hot Line II: FINESSE: abciximab alone or with reteplase before primary angioplasty for ST-elevation myocardial infarction.
17. Sabatine MS, Cannon CP, Gibson CM et al. Investigators. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med 2005; 352(12): 1179-1189.
18. Sabatine MS, Cannon CP, Gibson CM et al. Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study. JAMA 2005; 294(10): 1224-1232.
19. STREAM-Strategic Reperfusion (With Tenecteplase and Antithrombotic Treatment) Early After Myocardial Infarction. Drug Lib [online]. Last updated: 29. 2. 2008. Dostupné z: <http://www.druglib.com/trial/23/NCT00623623.html>.
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Paediatric cardiology Internal medicine Cardiac surgery CardiologyArticle was published in
Cardiology Review
2008 Issue 2
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